FRCS Applied Surgical Anatomy 2

Question 1

Which layer is entered first when performing a McBurney's point incision for appendicectomy?

Accepted Answer

External oblique aponeurosis

Answer

During open appendicectomy via a Gridiron incision at McBurney's point, the layers encountered are: skin → subcutaneous fat → Camper's fascia → Scarpa's fascia → external oblique aponeurosis → internal oblique (split in direction of fibres) → transversus abdominis → transversalis fascia → extraperitoneal fat → peritoneum.

Question 2

The portal vein is formed by the union of which two vessels?

Accepted Answer

Superior mesenteric vein and splenic vein

Answer

The portal vein is formed at the level of L1–L2 behind the neck of the pancreas by the union of the superior mesenteric vein and the splenic vein (which has already received the inferior mesenteric vein). This anatomy is critical in pancreatic surgery where the portal vein may be involved by tumour.

Question 3

During a Whipple's procedure (pancreaticoduodenectomy), which structure defines the plane of resection in assessing portal vein involvement?

Accepted Answer

The portal vein/superior mesenteric vein confluence

Answer

Resectability in pancreatic head cancer is determined by the relationship of the tumour to the superior mesenteric vein (SMV) and portal vein (PV). The SMV-PV confluence lies in the groove between the uncinate process and the neck of the pancreas; tumour involvement of this vessel indicates a technically demanding or borderline resection.

Question 4

The Triangle of Calot is defined by which three structures?

Accepted Answer

Common hepatic duct, cystic duct, and inferior edge of liver

Answer

Calot's triangle is bounded by: the common hepatic duct medially, the cystic duct inferiorly, and the inferior surface of the right lobe of the liver superiorly. The cystic artery is found within this triangle, and the Critical View of Safety (CVS) must be achieved before any clipping in laparoscopic cholecystectomy.

Question 5

Which nerve is at risk during a modified radical mastectomy due to its course along the chest wall?

Accepted Answer

Long thoracic nerve of Bell

Answer

The long thoracic nerve of Bell (C5–C7) runs along the lateral chest wall supplying serratus anterior. Injury during axillary dissection causes 'winged scapula' (inability to protract the scapula, winging on pushing against a wall), a debilitating cosmetic and functional defect.

FRCS Part A Practice Test

FRCS Part A Practice Test

FRCS Applied Surgical Anatomy 2